OBJECTIVETo improve the surgeon's understanding of pyoderma gangrenosum (PG) and avoid misdiagnosis and incorrect treatment.

METHODSThree cases of PG managed in the department of general surgery during the past 10 years were retrospectively reviewed.

RESULTSAll of the 3 cases mainly presented with necrosis of skin and soft tissues, followed by formation of painful and extensive creeping ulcer. They all had fever and were initially diagnosed and managed as "infection", but repeated wound exudates culture showed negative results and antimicrobial therapy was not effective. The ulcers were enlarged quickly despite of active debridement. Histopathology of ulcer biopsy suggested nonspecific inflammation. After the diagnosis of PG was established, systemic therapy with steroids and immunosuppressants were administered together with local wound care. The progress of the disease was controlled soon and fully resolved finally.

CONCLUSIONSPyoderma gangrenosum is misdiagnosed frequently. For severe patients, systemic therapy with steroids and immunosuppressants should be used as early as possible and skin lesions would heal together with mild local wound care.